Office or other outpatient visit, new patient, level 2
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Patient classification error (actually established patient)
Very CommonBilling new patient codes (99202-99205) for patients seen within past 3 years by same specialty in practice triggers automatic denials. This is one of the top 10 codes used in error.
Common Causes
- • Patient seen within 3 years by colleague in same specialty
- • Patient previously seen but changed insurance
- • Registration error marking established patient as new
Resolution Strategy
Resubmit with correct established patient code (99211-99215) based on complexity. Appeals rarely succeed if patient was actually established.
💬 Plain Language Explanation
What this means
This is a new patient office visit with a straightforward level of complexity. Your doctor performed a basic examination and made simple medical decisions.
Why you might see this
This code is used when you're seeing a doctor for the first time (or haven't seen them in 3+ years) and your visit was straightforward, requiring only basic evaluation.
Common context
Used for new patients with simple, straightforward medical issues.
What to ask your provider
"'As a new patient, was this a straightforward visit, or were there additional concerns that might justify a higher-level code?'"
Relative Value Units (RVUs)
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Clinical Information
When to Use
New patient visit with straightforward medical decision-making or 15-29 minutes total time
Common Scenarios
Documentation Requirements
- Chief complaint and history of present illness
- Problem-focused history and exam
- Straightforward medical decision-making
- OR document 15-29 minutes total time with activities
Coding Guidelines
Common Modifiers
Bundling Rules
- New patient defined as no encounter in past 3 years
- Cannot bill preventive visit same day without modifier
Exclusions
- Do not use for established patients (use 99212)
- Do not use if time <15 minutes (code does not exist)
- Do not use if time ≥30 minutes (use 99203)
Coding Notes
Clinical scenarios
- Chief complaint and history of present illness
- Problem-focused history and exam
- Straightforward medical decision-making
- Chief complaint and history of present illness
- Problem-focused history and exam
- Straightforward medical decision-making
- Chief complaint and history of present illness
- Problem-focused history and exam
- Straightforward medical decision-making
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Frequently Asked Questions
CPT 99202 is the billing code for "Office or other outpatient visit, new patient, level 2". New patient visit with straightforward medical decision-making or 15-29 minutes total time
Medicare pays approximately $69.87 for CPT 99202 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 99202 has a total RVU of 2.20, broken down as: Work RVU 1.10, Practice Expense RVU 1.01, and Malpractice RVU 0.09. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 99202 is "Patient classification error (actually established patient)". Billing new patient codes (99202-99205) for patients seen within past 3 years by same specialty in practice triggers automatic denials. This is one of the top 10 codes used in error. Common causes include: Patient seen within 3 years by colleague in same specialty; Patient previously seen but changed insurance. Appeal success rate is approximately 10-30%.
Key documentation requirements for CPT 99202 include: Chief complaint and history of present illness; Problem-focused history and exam; Straightforward medical decision-making; OR document 15-29 minutes total time with activities. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 99202: New patient defined as no encounter in past 3 years. Cannot bill preventive visit same day without modifier Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 99202 include: 25 (When E/M separate from same-day procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 99202 is 15-29 minutes total time on date of service. Time-based codes require documentation of the actual time spent providing the service.